BACKGROUND: Glycoprotein (GP) IIb/IIIa inhibitors can improve outcomes in patients with non-ST-segment elevation acute coronary syndromes but raise the risk of bleeding, particularly if dosed in excess. The impact of GP IIb/IIIa dosing feedback on safety and major bleeding is unknown. METHODS: Glycoprotein IIb/IIIa dosing feedback was added to the CRUSADE quarterly site reports in the first quarter of 2006. We describe GP IIb/IIIa use and dosing among 25,641 patients with non-ST-segment elevation acute coronary syndromes from the fourth quarter of 2005 to the fourth quarter of 2006. RESULTS: Eleven thousand eight hundred forty-six patients received GP IIb/IIIa inhibitors, including 4,031 women and 2,609 elderly patients (age, ≥75 years). Among GP IIb/IIIa-treated patients, unadjusted rates of excess GP IIb/IIIa dosing declined overall (26.4%-22.4%, Ptrend=.01) and among the elderly (65.6%-52.1%, Ptrend<.001). After adjustment, declines in excess dosing remained significant only for the elderly, although more than half of GP IIb/IIIa-treated elderly patients continued to receive excess dosing at the end of the study period (64.1%-51.3%, Ptrend<.001). There were concurrent declines in unadjusted major bleeding rates overall (9.6%-8.0%, Ptrend=.02), but declines among women (14.4%-11.5%, Ptrend=.08) and the elderly (17.1%-11.0%, Ptrend=.05) did not reach statistical significance. After adjustment for baseline characteristics and excess dosing, declines in major bleeding rates were no longer significant overall or for any subgroup. CONCLUSION: Within 9 months of initiating a safety feedback program, we observed early decreases in excess GP IIb/IIIa dosing among the elderly but minimal changes in excess dosing overall. Further work is needed to promote safe and effective medication use in vulnerable patients who are most at risk of harm.
BACKGROUND: Glycoprotein (GP) IIb/IIIa inhibitors can improve outcomes in patients with non-ST-segment elevation acute coronary syndromes but raise the risk of bleeding, particularly if dosed in excess. The impact of GP IIb/IIIa dosing feedback on safety and major bleeding is unknown. METHODS: Glycoprotein IIb/IIIa dosing feedback was added to the CRUSADE quarterly site reports in the first quarter of 2006. We describe GP IIb/IIIa use and dosing among 25,641 patients with non-ST-segment elevation acute coronary syndromes from the fourth quarter of 2005 to the fourth quarter of 2006. RESULTS: Eleven thousand eight hundred forty-six patients received GP IIb/IIIa inhibitors, including 4,031 women and 2,609 elderly patients (age, ≥75 years). Among GP IIb/IIIa-treated patients, unadjusted rates of excess GP IIb/IIIa dosing declined overall (26.4%-22.4%, Ptrend=.01) and among the elderly (65.6%-52.1%, Ptrend<.001). After adjustment, declines in excess dosing remained significant only for the elderly, although more than half of GP IIb/IIIa-treated elderly patients continued to receive excess dosing at the end of the study period (64.1%-51.3%, Ptrend<.001). There were concurrent declines in unadjusted major bleeding rates overall (9.6%-8.0%, Ptrend=.02), but declines among women (14.4%-11.5%, Ptrend=.08) and the elderly (17.1%-11.0%, Ptrend=.05) did not reach statistical significance. After adjustment for baseline characteristics and excess dosing, declines in major bleeding rates were no longer significant overall or for any subgroup. CONCLUSION: Within 9 months of initiating a safety feedback program, we observed early decreases in excess GP IIb/IIIa dosing among the elderly but minimal changes in excess dosing overall. Further work is needed to promote safe and effective medication use in vulnerable patients who are most at risk of harm.
Authors: Andrew D Michaels; Sarah A Spinler; Barbara Leeper; E Magnus Ohman; Karen P Alexander; L Kristin Newby; Hakan Ay; W Brian Gibler Journal: Circulation Date: 2010-03-22 Impact factor: 29.690
Authors: James W Hoekstra; Charles V Pollack; Matthew T Roe; Eric D Peterson; Ralph Brindis; Robert A Harrington; Robert H Christenson; Sidney C Smith; E Magnus Ohman; W Brian Gibler Journal: Acad Emerg Med Date: 2002-11 Impact factor: 3.451
Authors: Rosario V Freeman; Rajendra H Mehta; Wisam Al Badr; Jeanna V Cooper; Eva Kline-Rogers; Kim A Eagle Journal: J Am Coll Cardiol Date: 2003-03-05 Impact factor: 24.094
Authors: Jason M Lappé; Joseph B Muhlestein; Donald L Lappé; Rodney S Badger; Tami L Bair; Ruth Brockman; Thomas K French; Linda C Hofmann; Benjamin D Horne; Susan Kralick-Goldberg; Nan Nicponski; Janette A Orton; Robert R Pearson; Dale G Renlund; Holly Rimmasch; Colleen Roberts; Jeffrey L Anderson Journal: Ann Intern Med Date: 2004-09-21 Impact factor: 25.391
Authors: Timothy D Kinnaird; Eugenio Stabile; Gary S Mintz; Cheol Whan Lee; Daniel A Canos; Natalie Gevorkian; Ellen E Pinnow; Kenneth M Kent; Augusto D Pichard; Lowell F Satler; Neil J Weissman; Joseph Lindsay; Shmuel Fuchs Journal: Am J Cardiol Date: 2003-10-15 Impact factor: 2.778
Authors: Timo Lenderink; Eric Boersma; Witold Ruzyllo; Petr Widimsky; E Magnus Ohman; Paul W Armstrong; Lars Wallentin; Maarten L Simoons Journal: Am Heart J Date: 2004-05 Impact factor: 4.749
Authors: Sunil V Rao; James G Jollis; Robert A Harrington; Christopher B Granger; L Kristin Newby; Paul W Armstrong; David J Moliterno; Lauren Lindblad; Karen Pieper; Eric J Topol; Jonathan S Stamler; Robert M Califf Journal: JAMA Date: 2004-10-06 Impact factor: 56.272
Authors: Laura S Fernandes; James E Tcheng; J Conor O'Shea; Bonnie Weiner; Todd J Lorenz; Cindy Pacchiana; Lisa G Berdan; Kelly J Maresh; Diane Joseph; Mina Madan; Tift Mann; Rakhi Kilaru; Judith S Hochman; Neal S Kleiman Journal: J Am Coll Cardiol Date: 2002-09-18 Impact factor: 24.094
Authors: Sumeet Subherwal; Eric D Peterson; David Dai; Laine Thomas; John C Messenger; Ying Xian; Ralph G Brindis; Dmitriy N Feldman; Shaun Senter; Lloyd W Klein; Steven P Marso; Matthew T Roe; Sunil V Rao Journal: J Am Coll Cardiol Date: 2012-05-22 Impact factor: 24.094
Authors: Daniel W Mudrick; Bimal R Shah; Lisa A McCoy; Barbara L Lytle; Frederick A Masoudi; Jerome J Federspiel; Patricia A Cowper; Cynthia Green; Pamela S Douglas Journal: Circ Cardiovasc Imaging Date: 2012-10-16 Impact factor: 7.792
Authors: S A Wayangankar; M T Roe; A Y Chen; R S Gupta; R P Giugliano; L K Newby; J A de Lemos; K P Alexander; T A Sanborn; J F Saucedo Journal: Indian Heart J Date: 2016-01-18